Valvulotome



Oct. 13, 1953 B. RICHTER VALVULOTOME Original Filed Nov; 30, 1951 M 7 AV /1 m R m 0 T E N 5 III/Ll q WT m llllm vl W m w 6 I A 5 9 a 5 F 53 a q q W\ 8 4 q R U j l. 4 v {-5 V 4L NW m u .a 2 B be Patented Oct. 13, 1953 ED? sures or VA-LY-ULOTOME Bruno Richter, Glen-Ellyn; I11;

Giontinuatione oft appli'catiom Scfial No. 259391);

N ovemher: 30; .1951; Thiszaanplicatiom Decent" her 5, 1952,2Serial' No. 324,2;s

4, Claims; (Cl. 128-305)" Thisinvention relates-to surgical instruments and; more particularly to avalvul'otome; for- -operating on the pulmonaryvalve. i

It. is among the. objects of, the invention: to

provide an: improved valvulotomewhich is ex.-

-p ansible and collapsible and can be inserted to. operative. position in collapsed;- condition and,

then expandedtomakeqan.incisionof the desired.

depth; whichhas a stem; and cutting blades,-

disposed at respectively opposite sides of the stemiand convergently inclined relative to eachxtends with; aneinternal annular. rihon bead; I27

h chahutsathe -,innerrend of; the -stemv and liznits movement of. the stems inw r ly- Qfr th han -when the two parts are assemblfidstogetherr The shflnhand; stem;.togethenconstitute anelongated other; which has thecu-tting bladesdisposednear one end of the stem and manually adjustable; means atthe otherend of the ,stenrfer expanding and collapsing the blades; which hasmeans 553G112- rately indicating the extent of expansionofthe:

apparent from, a consideration-i; of: the following:

description and the appended;'claims in:;conjunc-- 'tion -with;the;- accompanying drawings, wherein:

Eigure: 1.- is: -a;-. side; elevational View of s, a Val-V11 5: lotomeillustrative of theinvention;

Figure 2 is; a cross-sectional view; on anen-.-. larged: scale taken-pnthe line 2-2:of Figural Eig11re;=.35:is. a transverse:crosesectionali view on an; enlarged 1 scale. taken: on the line: 3793: Fig-n 'ure,1;,,

Figure 4; is a fragmentary: cross-sectional I view on cthesline fl i'zofifiigure 2 and Eigure: 5 a. fragmentary cross-sectional view-- on;the;line;-5'-5sof Figure=21 With, continued; reference to vthe drawing; the valvulotomecomprises an enl'ongated handle or shank I0; of.square cross-sectionali shape having a bore; of circular cross-sectional shapeextendingcoaxially-therethrough from one end to the' tub ular-casina i: the" nstrument.;.

Arcn a hastalcylindriaalip rti n; Mi rec ived nthe endnfithe st m II :rem0tefr m thershank I Mand terminating; mean-annular shoulder overtii-na-Wfizadjaeent: end; of the: stem and- With outwardly: tapered, substantially conical" portion. I ,5:,-'.the distali end; of: which. is provided: with a.

tapped; hole, or; recess receiving. an screw-threaded a pin, lliaiwhich. has; airou-nded outerend; and: cons i utes he pointerthe instrument; The; cylin-. drical portion:- I41 of: the cap: is provided: with a diametricallyextending slot I 1 opening. tdthe end. of=the cap withimthe stem I I andsa pair of elongated; blades. t8 and I29 have each: one end.

disposedin. the slot. If! in. the cap: I3; The stem II isvprovided" at theendithereof' receiving thecap'i I h with; diametrically opposed; longitudinally extending slots 20 and 21 through which the hladeslare: movable,- these slots being longer than the bladesfor-apurposeto bepresently explained.

A pivot: pin; 2-? extends through the stem II and: theeap I3- transversely ofthe slot I! and through the endportions of the blades I 8' and I 9 received in the slot I-"I" and secures the cap in the adjacent end of the stem and also pivotallyconnects the -blad'esto the cap;

' A shaft 2-4 of circular cross-sectional shape extends through the boressof' the shank I 0 and stem- I I, butterminates short of the distal end oftlieshank, as isclearly-illustratedin Figure 2. 'I-hi'sshaft has in ane} end a diametrically extending; transverse: notch 25, and apair of, arms 26 and 21 are received each atone end in the notch ZS Qf-the-shaft: A, pivot pinili) extends through the notched end of'the shaft 24 transversely of the notch- 2 Sand through the ends of thearms' 2-6 and 21 received in the notch 25 pivotally connecting the arms to the, shaft, and. a;ps-pring.,

31"- has its loop; surrounding the pin 30* between the adjacent ends-of the arms 2fi'and'12l and its ends respectively engaging; these arms to resiliently'urge the arms outwardly through the slots 2'0and '2 I? in thest'em *H At-its end" remote from"; the shaft 24 the arm 26 is pivotall'y connected tothe end of blade I81 remote from cap It bya pivot pin 32 extending through the arm and the blade and at its endre-- mote from the shaft 24 thearm El is pivotal-1y 7 connected tozthe blade 82 an the end of this bladeremote from the cap I3 by a pivot pin 33.

The blades l8 and I9 and the respectively associated arms 26 and 21 constitute toggle link structures between the relatively fixed cap l3 and the adjacent end of the movable shaft 24, so that the blades will be swung inwardly or outwardly relative to the stem ll upon movement of the shaft 24 longitudinally of the stem in the corresponding direction. The blades are provided on their edges remote from each other with cutting edges, as indicated at 34 and 35, and the blades are normally convergently inclined in a direction from the arms 26 and 21 to the pivot pin 22, which pivotally connects the blades to the cap 13.

The spring 3| resiliently urging the arms26 and 21 outwardly relative to the stem H overcomes any tendency of the toggle link structures comprising the blades and the arms becoming locked in dead center position when the blades and arms are retracted to their limiting positions inwardly of the stem.

The end portion of the shaft 24 received within the shank or handle 10 is externally screwthreaded, as indicated at 35, and is flattened on opposite sides of its screw-threaded portion, as indicated at 37 in Figure 2.

At its end remote from the stem H the shank I is provided with a counterbore 39 which is co axial with the bore of the shank, but has a diameter slightly greater than the diameter of the remainder of the bore of the shank, and an elongated, tubular nut 40 has one end portion reduced in diameter to closely fit into the counterbore 3 of the shank H3. The other end portion of the nut 40 has an outside diameter substantially equal to the thickness of the shank ID and terminates in an annular shoulder 41 overlying the end of the shank l!) remote from the stem ll.

The portion of the nut 40 extending outwardly of the shank I0 is externally roughened or knurled, as indicated at 42, and this nut is provided with a bore 43, the end of which remote from the shank ill is outwardly beveled or flared, as indicated at 44, to receive the orifice end of a conventional syringe.

The portion of the nut within the shank I0 is annularly recessed externally, as indicated at 45, providing an elongated external groove terminated by shoulders 46 and 41 at its opposite ends. The shank It is provided in the portion thereof receiving the reduced end portion of the nut 40 with a tapped hole and a set screw 48 is threaded through this tapped hole and engages the shoulder 46 on the nut remote from the annular shoulder M to hold the nut against longitudinal movement in the shank while permitting free rotational movement of the nut, the nut being held against longitudinal movement in one direction by the screw 48 and in the other direction by the contact of the annular shoulder 4! with the adjacent end of the shank l0, and by engagement of the inner end of the nut with an annular internal shoulder it at the inner end of the counterbore 39 in the shank.

At its inner end the nut is internally screwthreaded and threaded onto the externally screwthreaded portion 36 of the shaft 24, so that rotational movement of the nut relative to the shank It will cause the shaft 24 to move longitudinally relative to the shank and the stem ll. Thus, by rotating the nut 46 in the appropriate direction, the blades l8 and H) can be caused to expand outwardly of or retract inwardly of the slotted end portion of the stem 1 l.

Intermediate its length the shank I0 is provided with a longitudinally extending slot 50 and with graduating marks 5| spaced apart longitudinally of this slot, and a screw 52 is threaded into a tapped hole in the shaft 24 and extends into the slot 5B. This screw 52 has a graduating mark 53 extending diametrically thereacross, which mark cooperates with the graduated marks 5| on the shank to accurately indicate the extent to which the blades are expanded outwardly of the stem l 1.

Thus, with this arrangement, the instrument may be forced in contracted condition through a wall of a heart, and then expanded to make an incision of predetermined depth through a stenotic valve. After the incision has been made, the instrument may be again fully contracted and removed without causing damage to the tissues through which it passes, and without causing ex tensive hemorrhage.

The entire instrument is preferably formed of a heat and corrosion-resisting material, such as stainless steel, so that it can be thoroughly sterilized before use and will not rust or corrode while in storage, and is carefully manufactured so that it is freely adjustable at all times without binding or distortion of its parts.

The invention may be embodied in other specific forms without departing from the spirit or essential characteristics thereof. The present embodiment is, therefore, to be considered in all respects as illustrative and not restrictive, the scope of the invention being indicated by the appended claims rather than by the foregoing description, and all changes which come within the meaning and range of equivalencyof the claims are, therefore, intended to be embraced therein.

This application is a continuation of application Serial No. 259,190, filed November 30, 1951, now abandoned.

What is claimed is:

1. A valvulotome comprising an elongated tubular shank of non-circular cross-sectional shape, an elongated tubular stem projecting longitudinally from one end of said shank with its bore in alignment with the 'bore of said shank and having longitudinally extending slots diametrically opposed at its end remote from said shank, an outwardly tapered cap secured to said stem in closing relationship to the distal end thereof, elongated blades pivotally connected each at one end to said cap and movable one through each of said slots, a shaft extending through said shank and said stem and having one end adjacent said slots and an externally screw-threaded portion disposed within said shank, arms pivotally connected each at one end to said shaft at said one end of the latter and pivotally connected at their other ends respectively to said blades at the other ends of the latter, said blades and the associated arms constituting toggle link assemblie connected between said cap and said shaft effective to swing said blades inwardly and outwardly relative to said stem upon longitudinal movement of said shaft in respectively opposite directions relative to said stem, a tubular nut threaded onto the screwthreaded portion of said shaft and having one portion thereof rotatably received in said shank and another portion thereof projecting from the end of said shank remote from said stem and externally roughened, means carried by said shank and engaging said nut holding the latter against longitudinal movement relative to said shank and enabling said nut to impart longitudinal movement to said shaft upon rotation of said nut relative to said shank, said shank having a longitudinally extending closed slot therein, means carried by said shaft and extending into the slot in said shank to indicate the extent of movement of said blades outwardly of said stem, and a spring engaging said arms and resiliently urging said arms and said blades outwardly of said stem.

2. A valvulotome comprising an elongated tubular casing having diametrically opposite 1ongitudinally extending slots in one end thereof, a cap secured to said casing in closing relationship to said one end thereof, a shaft extending longitudinally of the interior of said casing and having one end adjacent said cap and its other end adjacent the other end of said casing, said shaft having an externally screw-threaded portion at said other end thereof, a tubular nut having a portion rotatably secured in the other end of said casing and threaded onto the screw-threaded portion of said shaft and another portion extending longitudinally from said other end of the casing, means carried by said casing restraining said nut against longitudinal movements relative to the casing, elongated blades pivotally connected each at one end to said cap and extending one through each of the slots in said casing, and means extending through said slots connecting said shaft at said one end thereof to the other ends of said blades and effective to move said other ends of said blades toward or away from said casing upon longitudinal movements of said shaft in corresponding directions relative to said casing.

3. A valvulotome comprising an elongated tubular casing having at one end longitudinally extending slots angularly spaced therearound, a cap closing said one end of the casing, elongated blades connected each at one end to said cap within said casing and extending one through each of said slots, a shaft extending longitudinally of the bore of said casing and having one end adjacent said cap and its other end adjacent the other end of said casing, said shaft having an externally screw-threaded portion at said other end thereof, means connecting said one end of said shaft to the other ends of said blades and moving said other ends of the blades toward and away from said casing upon longitudinal movements of said shaft in the corresponding direction relative to said casing, and means engaging said casing at said other end thereof and threaded onto the screw-threaded portion of said shaft imparting longitudinal movements to said shaft upon rotational movements of the last-mentioned means relative to said casing.

4. A valvulotome comprising a casing, opposed cutting blades positioned adjacent one end of said casing and pivotally connected together at one end for movement toward and away from each other, a shaft extending longitudinally of and connected to said casing for reciprocatory movement, opposed arms pivotally connected together at one end to said shaft, the other end of each arm being pivotally connected to the other end of the corresponding blade, spring means operatively connected to said arms for urging said blades away from each other, and hand actuable means operatively connected to said shaft for effecting the reciprocatory movement of the latter to thereby cause the blades to move toward and away from each other.

BRUNO RICHTER.

References Cited in the file of this patent UNITED STATES PATENTS Number Name Date 68,647 Palmer Sept. 10, 1867 FOREIGN PATENTS Number Country Date 5,318 Great Britain of 1897 214,172 Germany Oct. 9, 1909 

